Risk Factors for Taiwanese MSM Men Visiting Gay Saunas

Since the global outbreak of HIV/AIDS, HIV has been transmitted among different vulnerable populations. According to a recent review, the global trend of HIV-1 infection among men having sex with men (MSM) has continued to increase, especially in East Asia, Africa, and Russia.  As of September 2011, there were 22,335 known cases of HIV infection in Taiwan, and Taiwanese nationals accounted for 96.5% of those cases. Of the Taiwanese nationals, 92.5% were male. Populations at risk for HIV infection include injection drug users (30.4%), homosexual men (38.3%), heterosexual men (21.6%), and bisexual men (8.1%). Therefore, MSM are a high risk group for HIV infection in Taiwan.

Since 1996-1997, the use of highly active anti-retroviral therapy (HAART) has significantly decreased HIV/AIDS-related mortality. It has been reported that unprotected sex has increased among MSM after the introduction of HAART, which has resulted in dramatic decreases in the morbidity and mortality from HIV-1 infection. Taiwan began to provide free HAART to all HIV-1/AIDS patients in April 1997. Although successful HAART can reduce the contagiousness of HIV-1, the fact that HIV-1 transmission still occurs in the ART-era indicates that transmission occurs from undiagnosed, untreated, or unsuccessfully treated patients.

Men having sex with men (MSM) accounts for 33.6% of all reported cases of HIV-1 infection in Taiwan. The aim of this study was to investigate the epidemiology of HIV-1 infection among MSM in gay saunas in Taiwan.

Patrons of 5 gay saunas were recruited for a weekly volunteer counseling and testing program from 2001 to 2005. Questionnaires were collected for a risk factor analysis. HIV-1 subtypes were determined using DNA sequencing and phylogenetic analyses.

HIV-1 prevalence rates among MSM in gay saunas in 2001 through 2005 were 3.4%, 5.1%, 8.9%, 8.5%, and 8.3%, respectively. In total, 81 of 1,093 (7.4%) MSM had HIV-1 infection. Fifty-two HIV-1 strains were genotyped, and all of them were subtype B. HIV-seropositive men were significantly younger than the seronegatives. Only 37.1% used condoms every time during sexual intercourse. A multivariate logistic regression analysis showed that the risk factors for HIV-1 were being uncircumcised (odds ratio (OR) = 2.19; 95% confidence interval (CI), 1.08~4.45); having sexual intercourse with at least 2 partners during each sauna visit ([greater than or equal to] 2 vs. [less than or equal to] 1, OR = 1.71; 95% CI, 1.02~2.89); and the role played during anal intercourse (versatile vs. an exclusively insertive role, OR = 2.76; 95% CI, 1.42~5.36).

Overall, 7.4% Taiwanese MSM participating in this study had HIV-1 subtype B infection. Uncircumcised, being versatile role during anal intercourse, and having sex with more than one person during each sauna visit were main risk factors for HIV-1 infection.

(The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production. )

by Chen YJ, Lin YT, Chen M, Huang SW, Lai SF, Wong WW, Tsai HC, Lin YH, Liu HF, Lyu SY, Chen YM

Source – MSM Sexual Health–Asia group.